Refrigerating Insulin

I ran ever so slightly high all day today. I never once dipped below 100. That, plus a fasting sugar level of >120 for the second day in a row has encouraged me to take some insulin. I'm going to take 2 units of Lantus.

Now taking 2 units of Lantus and checking for air bubbles with 2 units as directed would mean that of 250ml of insulin I'd only end up using about a fifth, and at the going rate of insulin these days that's a mighty big waste of money. So I went to the web, and did a little digging, and based on what I found I'm going to take the following course of action.

For starters I won't check for air bubbles with 2 units. I'll check with one unit at a time until an actual bead of insulin pushes through the needle. Second, I'm going to keep the insulin in the refrigerator and only take it out for long enough to inject, after which I'll return it to the frige. If at any point the insulin becomes cloudy, lumpy or changes colors I will dispose of it immediately. However, if the insulin stays clear and colorless I will continue to use it until it is empty. I'll keep you posted on the results.

Dailies:

11:12 -> 122 That's two days in a row of waking up a little high. Took 2 prandin with cereal 110c. Then over the next few hours, apple 50c, and pumpkin seeds 5c, mandarin orange 9c and bell pepper 8c.
5:04 -> 110 Took 2 Prandin with chili 80c, chips 18c, salad 30c, hummus 15c, grapefruit 25c, pb & banana 55c.
8:14 -> 145 That's a good number to start Joey. had an apple 15c and pumpkin seeds 5c at intermission.
12:50 -> 104 Took 2 Prandin with brussels sprouts 18c, okra 18c, butternut squash 60c, seaweed 6c, nutritional yeast 4c.
3:30 -> 187 Going to bed on this number, glad I decided to take 2 units of Lantus. Let's hope I sleep restfully through the night and wake up between 80-100.

Day 94

Goal: Becoming a Diabetic Leader

I want to make this operation bigger. I've been looking on Craigslist, JDSU websites, meetup.com and I can't really find the type of thing I'm looking for. I know there are bad diabetics out there. I hear about them all the time. And this pains me more than a cold injection into muscle tissue... or at least it pains me equally.

I want to find a way to get in contact with them and convince/teach them how to be better. My diabetic nurse sort of does this, but she has the restrictions of having to say certain things for legal reasons (such as change your insulin after 28 days). Certain individuals have maintained rigid glucose control since the dawn of insulin in the 1920s. Why then are people still showing up to the hospital with A1Cs in the teens, months or years after their original diagnosis?



Dailies:

9:40 -> 121 Don't get used to this time of day, I was just meeting a friend for b-fast which I ate at 11:00. Took 2 Prandin with vegan/gluten free lasagne. Not bad, but it was certainly over priced for what you got. About 80c and an apple 15c.
2:06 -> 119 Took 1 Prandin with a glorious Cameo apple 30c and my leftover swiss chard with squash 60c.
6:22 -> 71 Took 2 Prandin with lentil soup with rice 110c, grapefruit 25c, pb and banana bagel 50c, apple 30c, salad 20c, bread with hummus 20c.
9:54 -> 89 I only checked because I assumed I'd be high after 255 carbs, but this is a great number. Had a cookie 17c.
1:05 -> 65 Dang, and they tell me I'm not producing insulin. Had a salad (rocket, cucumber, tomato, avocado, onion, balsamic, soy chorizo) 45c.


Got some Vitamin D the old fashioned way today, and have a lobster red patch the size of a bear paw on my left arm.

Day 93

A Wake Up Call

Literally, five minutes before my alarm was scheduled to go off I received a phone call from my Diabetic Nurse, Linda. Her motherly voice showed no signs of resentment after I absentmindedly stood her up last week. We had scheduled an appointment two months in advance, and life caught up with me. No hard feelings though.

She wanted to check in, and since she hadn't received the news of my most recent blood work I was able to witness her organic reactions. We hadn't talked in so long that it was the first she had heard about me giving up daily insulin injections. I explained the reasons surrounding my decision, the middle of the night crashes and she supported my decision. But then I gave her the news of my new C-Peptide levels* and she, like Dr. Thys, encouraged me to be prudent in watching my sugar levels, and if they started creeping up to start back on daily injections of Lantus but at very low doses (2 units probably).

I was sure she would be thrilled to find out my A1C was 6.1%, but was mistaken. She saw this number as evidence that i was experiencing too many lows (I was) and would rather see me at about 6.5% she said. Towards the end of the conversation she cracked a joke at how obsessive I was about my control and we both had a good laugh. At least she's starting to get to know me!

I didn't tell her about my cholesterol which I mistakenly quoted as having dropped from 170-136 in my last post. It actually dropped to 126. My triglycerides were 51. Those are some healthy arteries.

When I hung up I went to check my sugar levels fully expecting to be as high or higher than the day before. After all my C Peptide is back at .53 which is super low. Surely Prandin alone can't encourage enough insulin production for somebody with my appetite... or can it?

Dailies:

11:40 -> 83 Woah! Back in the money! Took 2 Prandin with c ereal 110c, apple 15c, orange 20c, pumpkin seeds 6c. At 3:30 had bread with hummus 18c, and a clementine 9c.
4:50 -> 95 Great! Took 2 Prandin with dinner of Black Eyed Peas with kale 105c, grapefruit 25c, orange 20c, bagel with peanut butter and banana 54c, grapefruit 25c, blueberries 19c.
11:36 -> 76 Took 2 Prandin with black bean pasta 64c, indian eggplant 26c, chard and squash 15c.
1:55 -> 98 Dang! That's a day of freakin' great numbers and I never felt hungry either. Had 30c more of the squash swiss chard mix to give me a little boost for the night.

With numbers like these I don't think I'll be back on the insulin soon. But my C Peptide is low. So how is this possible? Wanna hear my theory? Sure you do.

I am (very wishfully) thinking that perhaps due to my high level of activity and my very healthy and fiberful diet maybe I just don't need as much insulin as other people. There is a range after all, from about .8 to about 3.2. If you're >3.2 then that's pre-diabetic for Type 2 meaning that you produce tons of insulin but don't use it efficiently. Isn't it possible then that somebody who's low is actually just very efficient? I mean, I didn't test above 100 once today. And I ate almost 600 carbs today with only 3mg total of Prandin. What would more insulin do to me?

Anyway, I go in for more tests in a week. But in the meantime I'm very pleased with my most recent blood work numbers.

Day 92

Blood Work: Part 4

I got my blood results today. This is the fourth time I've had blood work done. The first time was with my initial visit to the doctor. The second time only a few weeks later. The third was six weeks after that, and the fourth (most recent) was last week, three months from my initial diagnosis. There's no point in building suspense, I have to take the numbers and the results as a quarterly check in, to see how I'm doing. As always seems to be the case there was some good news and some bad news. The good news was good, the bad news... well, you'll see. (I'm recording these from memory, when I get a copy of the blood work I'll copy edit to make sure all numbers are accurate.)

GOOD NEWS:
Hemoglobin A1C: 6.1% This is amazing news. If I can maintain this number for life it is unlikely that I'll ever experience diabetic complications. Other than a freak high or low, complications are the biggest fear/concern (or should be) of all diabetics. A 6.1% A1C means that my average blood sugar level is about a 126.

Total Cholesterol: 126 Also amazing news. Cholesterol levels are a great indicator of heart and artery health. Even a level of 150, though well below the acceptable level as stated by the American Heart Association of 210, has been shown to increase your chance of heart disease. When I first got tested I was a 170, which is a good number for an American, but a bad number for a diabetic who is determined to live a long healthy life. A 126 on the other hand is amazing! I have to attribute this to my new dietary choices.

BAD NEWS:
C-Peptide: .53 This number will continue to fluctuate, a symptom of type 1.5 diabetes, and one of the biggest challenges I'll face in the next few months/years. The number indicates how much insulin my own body is producing. As this number increases so does my natural insulin production making my blood sugar more stable. As this number goes down (.5 is low) I'll be prone to higher and higher blood sugar levels. In response to this number my doctor put the responsibility of treatment in my hands. In her own words she reminded me that I knew how the Lantus and Novolog and Prandin worked, and to search for a balance with any combination I felt appropriate.

TH: Low. I forget the actual number, but this represents the hormone produced by the Thyroid. Mine is hardly producing at all. I am now the proud new recipient of hypothyroidism (more on that later). She's going to give me two weeks and then have me repeat this blood test. If the results stay the same or get worse I'll have yet another pill...to take daily...for the rest of my life.

So the good news is after a mere 3 months, the things that are in my power to control have been controlled. I've virtually disease proofed myself against a host of complications, and proved to myself that I'm smart enough, willful enough and strong enough to do that.

The bad news is that for the unforeseen future I'm shooting at a moving target when it comes to blood sugar regulation. I'll have to be flexible and alert. And the next few weeks may be rough. Hypothyroidism can cause sluggishness, fatigue, depression, etc. I fear a weekend trip to the Hamptons is only a temporary fix.

Dailies:

11:30 -> 138 That's the highest fasting level I've had since February 4th, not a great sign. Took 2 Prandin with cereal 110c. Walked several miles.
2:44 -> 123 That's better, I guess I'm still producing some insulin. Took 3 Prandin with black eyed peas 100c, apple 30c, clementine 9c, grapefruit 26c, lentils 20c. At 6:00 had bagel with pb & banana 55c
6:50 -> 117 Woah! Awesome, that right after having a bagel too! Had a piece of bread with hummus 20c. Performing as Joey. At 8:30 I had a cupcake 12c, pumpkin seeds 6c, and bread with jam 16c. At 12:00 I had a shot of tequila and a Larabar 26c.
1:54 -> 105 Great! Took 2 Prandin with salad 30c and brussel sprouts with cabbage 30c. If I'm above 150 before bed I'll take 2 units of Lantus with a little snack.
3:21 -> 104 Wow! Looks like the Prandin is still working today. I'll have an orange 20c and some blueberries 16c and go to bed.

Day 91

Black Eyed Peas (and bike ride!)

And there are many reasons why.

In anticipation of getting an early morning phone call to go shopping at the Park Slope Food Coop (best produce in the city) I went to bed early the previous night. I explored my neighborhood before 11:00 (when I usually wake up) and found the energy tangible. I also stopped to get a few more vegan flavor enhancers: miso, kombu, dried mushrooms (soon I'll add nutritional yeast to my arsenal as well!).

I got several errands done before noon, before settling down to watch a film. When 2:00 rolled around and I realized that I had been stood up by my workout partner I decided the day was too good to waste indoors and so I took my gorgeous 20 year old Trek 1000 "Sea Way" out for a spin. I started by coasting down the hill, then took a right when I hit a red. This eventually lead me to a bridge, which I crossed, and then was spit out at the hudson river, so I turned north and started pedaling stopping once to pee and drink some water but otherwise just chugging along in t-shirt and shorts with the full force of an abnormally radiant March sun carrying me along. Couples were making out on the green, old men were fishing, children were wobbling along on their scooters and everybody was happy and grateful to be outside in 70 degree weather for the first time all year. Even the cherry blossoms had begun to bloom, explosions of pink as if from a fairy that just vanished. I felt as if I was running from sun and chasing speed. It felt good to go fast, to sweat, my thighs simmering with every rotation. When I hit the 190s I called a friend who lived in the area and then stopped at his apartment. I'm converted.

He pays less for an old three bedroom apartment that was gutted and renovated to be a huge 2 bedroom apartment then I did in queens for a medium two bedroom apt. He has a corner apartment with seven windows on the fifth floor overlooking the cloisters. It's amazing! And I caught him in a 30 minute window of when he was home in the afternoon, before heading off to his birthday dinner, and then I was off again. This time homeward bound.

The ride home seemed much faster despite riding against the wind, with quickly tiring legs and into the sun (I need some sunglasses). I got home right as the sun set, a 35 mile ride in total. If I get more comfortable with that type of mileage I can start going to some pretty exciting places.

Back at home, the black eyed peas I had been soaking all day were ready to be cooked.

Black Eyed Peas

1 onion chopped
4 stalks celery chopped
2 jalepenos chopped
1 bell pepper chopped
7 cloves garlic smashed
3-4 cups soaked and strrained black eyed peas
2 cups kale leaves

Cumin, Paprika, Chili Powder, Coriander, Cinnamon, Apple Cider Vinegar, Salt to taste.

 Brown the onions, celery, jalepenos, bell pepper and garlic and then added the BEPs with water enough to cover them. Next add the cumin, paprika, chili powder, coriander, cinnamon, apple cider vinegar and salt. An hour later I added kale leafs and served. It was divine. For a hungry man I couldn't have asked for a better meal.

I served it along an arugula salad with olives, cucumbers, tomatoes, avocado, onions, sprouts and sunflower seeds, and a seaweed (kombu) salad with sesame, rice vinegar and sesame oil.

Dailies:

10:48 -> 129 A tad high for the morning. Took 3 Prandin with cereal 110, grapefruit 25c, apple 15c, yellow pepper 7c, 2 kiwis 20c.
2:17 -> 138 Had indian food with spinach 60c then went for 35 mile bike ride during which ate an apple 15c and apple sauce 30c.
6:40 -> 79 Had 2 clementines 18c, then took 3 Prandin with salad 40c, seaweed 10c, black eyed peas w/kale 100c, then orange 18c and fake coffee 4c and raw bok choy 3c.
1:42 -> 145 Still a bit hungry, I probably should have eaten more right after dinner while the Prandin was still in my body. But supposedly it has a half life of an hour, so now would be too late to eat anything substantial despite being hungry.

Tomorrow I'll have to stuff myself a bit to make sure to make up for the calories burned on the ride.

Day 90

Happy Diabetic St. Patrick's day

                                                      (now THAT'S not on a vegan diet!)

Top of the Morning to ya!!

Tis the day of all things green, in honor of the holiday I started my morning with a cup of black tea and Jameson's, some blood pudding, beans and toast, sausage, bacon, eggs, and a bowl of oatmeal cooked in Guiness. And then I woke back up to the reality of my situation. 

As each holiday passes, and granted this isn't very high on the list of major US holidays, my new lifestyle will be put to the test.  Christmas will not be about figgy pudding, Valentine's day will have to be chocolate free, and today my corned beef with cabbage will have to be just corn... with cabbage.  I'll have to relearn the 4th of July without bbq, birthdays without cake, and halloween with only tricks (and maybe some roast pumpkin!)... ok, enough moping. I actually had a great day. And food wasn't problematic at all, in fact, it's very easy, on a vegan diet, to eat green foods.  So my dinner was very festive.


Dailies:

11:14 -> 120 Took 3 Prandin with cereal 110c then pb and banana 50c, apple 15c, kiwi 10c, grapefruit 25c.
4:56 -> 92 Took 2 Prandin with lentil soup 140c, pepper 7c, cupcake 14c, apple 15c, another apple 15c, berries 5c, grapefruit 22c and pumpkin seeds 10c.
11:30 -> 83 Awesome! took 2 Prandin with dinner: salad 30c, brussel sprouts 25c, cabbage 15c and a GREEN'S beer.
3:41 -> 86 This is good! Finished earlier cabbage and had an apple 15c and celery 8c to cover for any potential dips caused by the beer.

Day 88

Fraud Alert for People with Diabetes

I received this email today from a Diabetes organization. Copied in its entirety is a message to Diabetics warning them of criminal acts of fraud targeting diabetics.  I'm sure I don't have to tell you how upset this makes me. News like this leaves me wishing for a prehistoric justice system.  Here's the warning:

"Criminals who plot to defraud the Government and steal money from the American people have a new target: people with diabetes.
Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you. The caller offers "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics, or joint braces, in exchange for the beneficiaries' Medicare or financial information, or confirmation of this type of personal information. Additionally, you may receive items in the mail that you did not order.

The call is a scam.

If you receive such a call, OIG recommends the following actions:

1. Protect Your Medicare and Other Personal Information

Do not provide your Medicare number or other personal information. Be suspicious of anyone who offers free items or services and then asks for your Medicare or financial information. These calls are not coming from Medicare, diabetes associations, or other similar organizations. While the caller says the items are "free," the items are still billed to Medicare. Once your Medicare information is in the hands of a dishonest person or supplier, you are susceptible to further scams. Alert others about this scheme, and remind them not to provide strangers Medicare numbers or other personal information.

2. Report the Call to Law Enforcement

Report the call to the OIG Hotline at 1-800-HHS-TIPS or online at www.OIG.HHS.gov/fraud/hotline. As part of your report, provide the name of the company that called you, the company's telephone number and address, and a summary of your conversation with the caller.

3. Check Your Medicare Summary Notice and Medicare Bills

Check your Medicare Summary Notice and other medical information to see if you were charged for items you did not order or did not receive. Also, check for items that were billed multiple times, such as glucose meters, diabetes test strips and lancets, and other supplies. Report any irregular activity to your health care provider and the OIG Hotline at 1-800-HHS-TIPS or online at www.OIG.HHS.gov/fraud/hotline.

4. Do Not Accept Items That You Did Not Order

You are under no obligation to accept items that you did not order. Instead, you should refuse the delivery and/or return to the sender. Keep a record of the sender's name and the date you returned the item(s) to help OIG catch any future illegal billing.

The Department of Health and Human Services, Office of Inspector General (OIG) fights fraud in Government programs. As part of this effort, the OIG relies upon alert citizens to help them catch those who steal from American taxpayers."

 

Dailies:

11:11 -> 87 Took 3 Prandin with cereal 110c, then apple 25c, kiwi 10c, 1/2 grapefruit 13c, apple 25c, 2 cookies 25c and a pb&j 30c at 4:00. Boy it feels good to eat after yesterday's workout!
5:05 -> 92 Took 2 Prandin with TJs salad 53c, cabbage stew 15c and then took a third Prandin with lentil soup 140c and a grapefruit 22c.
8:33 -> 175 Still pretty hungry, but not going to eat with a number this high.
11:28 -> 87 Took 2 Prandin with dinner: salad 25c, brussel sprouts with kale and jalepenos 20c, bell pepper 7c, pumpkin seeds 15c.
3:18 -> 104 Cookie 9c, kiwi 10c.

This was the greatest number of Prandin I've taken in a single day: 8 and yet the numbers didn't seem that much better or worse than usual. Perhaps I got the dosage right finally, or perhaps it's something else. I have a hypothesis brewing.

Day 87